A nutritionist uses a standard EER formula to counsel a client who then gains weight despite following the calculated kcal target. Which critical appraisal best explains why this occurred and how to proceed?

• A. The only solution is to double the prescribed calories because EERs always underestimate energy needs for adults, regardless of individual differences.
• B. The client must have intentionally misreported intake; formulas are exact and any deviation can only be due to dishonest behavior, so no formula adjustments are needed.
• C. Weight gain indicates the EER calculation was invalid for that sex and should be discarded in favor of the EAR as a replacement for daily energy targets.
• D. Population-based EER formulas provide estimates that may not account for individual metabolic differences or reporting error; the nutritionist should verify reported intake and activity and adjust calories based on observed weight change over time.

Answer: (D)